Evaluation of a new diabetes screening method at the Derbarl Yerrigan Health Service

Abstract

Background and Objectives: Diabetes is a major health problem for the Aboriginal population of Australia. Early detection is a key strategy to reduce the burden of diabetes. The aim of this study was to assess the acceptability, sensitivity and specificity, effectiveness and cost of a new method of screening for diabetes at Derbarl Yerrigan, the Aboriginal health service in Perth. Methods: Between January and May 1999, all clients over the age of 30 years and not known to have diabetes were approached for HbA1c testing using the DCA 2000 analyser. Those whose HbA1c results indicated the need for follow‐up were asked to return for confirmatory testing using the gold standard oral glucose tolerance test (OGTT). A questionnaire was administered to participants who did not return. A file audit was conducted over 15 non‐consecutive days to determine screening, follow‐up and the number of new cases diagnosed using the previous ad hoc approach to screening with a glucometer. Result: 238 clients were approached and all agreed to participate and undertook the test. Of these, 37 were referred for follow‐up diagnostic testing. Of these, only 14 had an OGTT. Among these 14, five were found to have diabetes and three were found to have impaired glucose tolerance. Of the remaining 23 participants, we were able to contact only six and administer the questionnaire to four. Poor follow‐up meant that the sensitivity, specificity and cost‐effectiveness of the test could not be assessed. Conclusions and Implications: The reasons for poor follow‐up need to be investigated if Aboriginal health services are to be more successful at screening for diabetes.

Socioeconomic status and diabetes among urban Indigenous Australians aged 15–64 years in the DRUID study

“…The successful implementation of these health checks, including screening for diabetes as appropriate, depends on a number of factors, such as raising awareness among general practitioners, improving cross-cultural communication, providing appropriate incentives, increasing demand among Indigenous patients, and eliminating out-of-pocket costs through bulk billing (Mayers & Couzos 2004). Adequate follow-up of abnormal results is essential, but this can be challenging for any health service, even one that is controlled by the local Indigenous community (McAullay et al 2004). Increased opportunities and support for physical activity and improved dietary quality are also critically important, both in their own right and as part of strategies to reduce the burden of obesity.…”

Successful chronic disease care for Aboriginal Australians requires cultural competence

“…Pathway to Care describes the patient's journey through the health system – beginning with a perceived need for care, identification of and access to a health service, consulting a primary care clinician, receiving an appropriate assessment and diagnosis, being provided with appropriate management and care plans, and monitored and supported to adhere to a care plan and achieve better health outcomes 27 . The physical, economic and sociocultural aspects of Access to Care include availability (patients’ knowledge about the services and patients’ confidence in being able to receive the medical care they require), accessibility (relationship between location of services and the patients (distance, transport, cost), affordability (relationship between costs of services and extent to which cost is seen as a barrier to service use), accommodation (relationship between extent to which service delivery arrangements are able to accommodate patients’ needs and the extent to which doctors’ attitudes are seen to be accommodating of those needs) and acceptability (relationship between perceived need for improvement in the service delivery arrangements and patients’ satisfaction with the arrangements) 28…”

The health of urban Aboriginal people: insufficient data to close the gap

“…There are, however, some studies in progress that may provide more detailed information about the health of urban Indigenous people. For example: the Study of Environment on Aboriginal Resilience and Child Health (SEARCH) is a long‐term study of urban Indigenous children attending four Aboriginal medical services in New South Wales; 35 the Antecedents of Renal Disease in Aboriginal Children and Young Adults (ARDAC) is a study of children and kidney disease; 36 the Gudaga Study is based on a birth cohort in south‐west Sydney; 37 the Kanyini Vascular Collaboration is engaging with Indigenous patients at high cardiovascular disease risk; 38 DRUID is a large‐scale study of urban Indigenous people in Darwin; 39 , 40 and recent studies have been undertaken at Derbarl Yerrigan Health Service in Perth 20 , 25 . All of these studies and others will provide important information in the coming years.…”